Critical In Usmani and Ahmad, J Perioper Crit Intensive Care Nurs 2017, 3:1

Journal of Perioperative &

e& t
DOI: 10.4172/2471-9870.10000138
v

en
f preoperati

siv
e Care N
ISSN: 2471-9870
Critical Intensive Care Nursing
lo

u
rs
na ing
Jour

Research
Review ArticleArticle Open Access

Health Status of Children in India

Gulnawaz Usmani* and Nighat Ahmad
Department of Economics, Aligarh Muslim University, India

Abstract
India with a population of 1.21 billion population stand at the second position as the most populous country in
the world after China. India comprises almost 13.1 per cent of child population aged 0-6 years. Children of today
are tomorrow’s citizens; hence it is very necessary to provide better health care facilities to them. India accounted
almost 43 per cent underweight children against 32 percent in Pakistan, 9 percent in South Africa. Nutritional level
among the children is the basic element of their overall mental and physical development. Malnutrition among the
children reduced significantly over the time, but still the number of malnourished children is very high in the country.
Malnutrition and mortality among children are the two faces of a single coin. Mortality among infants and under-5
children is also a major concern. In India the number of under-5 mortality rate and infant mortality rates are 49 and
42, respectively. Thus there is a need, to be more focused on the child health issues. The main objective of this paper
is to study the child health condition in terms of nutrition and survival rate. The study is based on the secondary data
from various published reports of the government of India.

Keywords: Child health; Malnutrition; Vaccination; Immunization;
Infant mortality rate; Child mortality rate; Under-5 mortality rate
Introduction
India, with 1.21 billion of population is the world’s second most
populous country after China. An estimated 26 millions of children
are born every year. It is alarming that with an absolute increase in
population of about 181 million in the population during the census
2001 and 2011, there is a reduction of 5.05 million in the child
population aged 0-6 years during the same period. According to 2011
census, the total number of children aged 0-6 years is 158.79 million
which is reduced by 3.1 percent compared to the child population in
2001 census. According to the data available the share of children of
the age group 0-6 years to the total population is 13.1 percent in 2011.
Children of today are tomorrow’s citizen, thus it is extremely
important to ensure good health for children. Child health plays a vital
role in the development of a country. The first six years of life constitutes
the most crucial span in life. At this stage if life, the foundation are laid
for mental, physical and social development. Children are the assets for
tomorrow’s productivity. The growth of any country is depending on
the availability of healthy human resource. As children represent the
future generation, thus makes them healthy is of crucial importance.
Healthy children ensure for healthy adult who in turn ensure a sound
growth and development of the economy. New-borns particularly
infant and under-five children are more vulnerable to malnutrition,
mortality and other diseases, which can be easily prevented or treated.
India is listed in the countries where malnutrition and child
mortality is alarmingly high. According to the data released by the Office
of the Registrar General of India, indicate that although the mortality
rate especially infant and under-five mortality rate is declining over the
years, yet there are some states where these rates are very high. This
shows that instead the progress in health care sector in India, young
population especially in the age group 0-6 years continuously lost
their lives due to inadequate nutrition and proper care. The mortality
rates and nutritional status of the children reflects the threats in child
health. Despite various measures and programmes to control the
malnutrition and mortality among children the condition remains a
cause of serious concern that need to be addressed urgently. The latest
survey on children brought out by the ministry of Women and Child
Development titled “Rapid Survey on Children - 2013-2014” [1] shows
the deprived condition of children in the country.
The present paper made an attempt to study the child health issues
related to the nutrition and survival. Nutrition is the basic element of
healthy life. Adequate nutrition is very essential in the early stages of
life. Nutrition helps in the growth and development of body. Indian
has the largest food supplementation programme in the world.
Although country experiences rapid economic growth and easy access
to affordable food and food supplementation programmes for children,
yet there are nearly half the under-five children are underweight.
Another important concern of the paper is child mortality. Despite
progress in health sector, India has very high child mortality rates. The
child mortality rates reflect the threats in child health. Malnutrition is
the major cause of mortality among children.
The study is based on the secondary data collected from various
government reports such as NFHS reports, World Health Organization,
Rapid Survey on Children report [1], Sample Registration System
Survey reports, etc.
International Comparison of Child Health
Internationally child health has approved as the most important
indicator for the development of the world. In every country the
respective governments have made every possible effort to tackle down
the prevalence of underweight children. Underweight percentage
reflects the percentage of malnutrition. According to the World Health
Organization (WHO) [2], 43 percent of Indian children are underweight.
Figure 1 shows the underweight children in the developing countries.
From the figure it is cleared that India is far behind in the health status
of children comparatively to other neighboring countries. Among
these countries India (43%) has the highest percentage of underweight
children. The percentage of underweight children in China is 4
percent, Brazil (2%), South Africa (9%). The percentage of underweight
*Corresponding author: Gulnawaz Usmani, Research Scholar, Department
of Economics, Aligarh Muslim University, Aligarh, UP, 202002, India, Tel:
+919358171745; E-mail: nawaz1717@gmail.com
Received March 15, 2017; Accepted March 23, 2017; Published March 30, 2017
Citation: Usmani G, Ahmad N (2017) Health Status of Children in India. 3: 138.
doi:10.4172/2471-9870.10000138
Copyright: © 2017 Usmani G. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.

J Perioper Crit Intensive Care Nurs

ISSN: 2471-9870 JPCIC, an open access journal Volume 3 • Issue 1 • 10000138
Citation: Usmani G, Ahmad N (2017) Health Status of Children in India. 3: 138. doi:10.4172/2471-9870.10000138
43
45
40
32
35
30
25
20
15 9 45 percent in NFHS-3 round. Between these two rounds of NFHS, the
10 4 percentage change in the percentage of stunted children is only -0.12
2
5 percent. The most recent survey “Rapid Survey on Children” (RSoC)
0
Brazil China South Africa India Pakistan
Source: World Health Organization [2]
Figure 1: Underweight children in the developing countries (%).
children in Pakistan is also very low comparatively to India. Pakistan
has only 32 percent of underweight children. The health condition of
children is worst in India comparatively to other developing countries.
Though Country experience higher economic growth but stands far
behind in terms of underweight children in the world comparatively to
other developing countries. Data from the Rapid Survey on Children
(RSoC) reported that 29.4 percent Children was underweight in 2013-
2014 (Annexure 2). Stunted children are also reported as high as 38.7
percent in India in 2013-14 (Table 1).
According to former Vice President of India, Hamid Ansari: “it
seems the state you are born in determines how long you live”. Table
2 presents the extent of malnutrition in India and major states. Child
malnutrition measures are based on weight-for-age, height-for-
age and weight-for-height. Each of these measures gives somewhat
different percentage of nutritional level of children. The weight-for-
height index measures body weight in relation to body height, case of
acute malnutrition. Height-for-age index measures growth retardation
(stunting) among children, case of chronic malnutrition. Weight-for-
age index reflects both the case of chronic and acute malnutrition.
Nutrition plays a central role in human well-being. Nutrition acts both
as an essential element of and a vital input to other aspects of well-
being and development. On the other side, under-nutrition represents
a deprivation of basic aspects of well-being.
The implications that child malnutrition have for growth and
development are multiple and cumulative. About 38.7 percent of
children were stunted, 15.1 percent were wasted and 29.4 percent
of children were underweight in India in 2013-14 (RSoC 2013-14).
Among the states, Uttar Pradesh (50.4) has the highest percentage
of stunted children followed by Bihar (49.4), Gujarat (41.6), Madhya
Pradesh (41.5) and Assam (40.6). The states of Kerala and Tamil Nadu
have the lowest percentage of stunted children. Kerala has only 19.4
percent and Tamil Nadu has 23.3 percent of stunted children. The
percentage of wasted and underweight children for India is 15.1 percent
and 29.4 percent, respectively. The numbers of malnourished children
are quite high in the country. In terms of wasted and underweight
children, the highest percentage of wasted children is in the states of
Tamil Nadu (19) followed by Gujarat (18.7), Bihar (13.1), Karnataka
(17), Kerala (15.5), Madhya Pradesh (17.5), Maharashtra (18.6) and
Odisha (18.3). The lowest number of under-weight children is in the
states of Punjab (8.7) followed by Haryana (8.8) and Uttar Pradesh
(10). On the contrary, underweight children are quite high in the
country and in states. The states of Bihar and Madhya Pradesh have the
highest number of underweight children among the major states in the
country. Bihar (37.1) has the highest number of underweight children
J Perioper Crit Intensive Care Nurs
ISSN: 2471-9870 JPCIC, an open access journal
Page 2 of 7
followed by Madhya Pradesh (36.1), Uttar Pradesh (34.3) and Gujarat
(33.6). The lowest number of underweight children is in the states of
Punjab (16) and Kerala (18.5).
Table 2 presents the percentage change of nutritional status
in children in the country over the time. In the NFHS -2 survey 51
percent of children are stunted in the country which gradually down to
conducted by the ministry of Women and Child Development reported
that in the country, the percentage of stunted children down to 38.7
percent in 2013-2014 from 45 percent in 2005-2006. The percentage
decline stunted children between NFHS-2 and the RSoC is -0.24.
During NFHS-2 [3], the percentage of wasted children in India
is 20 percent. The number of wasted children increased to 23 percent
in NFHS-3 [4]. The percentage increase between these two rounds
of National Family Health Survey (NFHS) is 0.15 percent [5]. The
percentage of wasted children in India further declined to 15.1 percent
in 2013-2014. Between NFHS-2 and RSoC the percentage declined in
wasted children is -0.25 percent. Country seems highest percentage
decline in the underweight children. The percentage declined over the
period between NFHS-2 and RSoC in underweight children is -0.32.
The percentage of underweight children is 43 percent in the country
during NFHS-2. The number reduced to 40 percent in NFHS-3. During
these two rounds the percentage declined is -0.070. Trends from NFHS-
2 to RSoC show an overall significant declined in stunted, wasted and
underweight children in the country.
Table 3 presents the huge social disparities in the extent of child
malnutrition. There is a large gap between the social groups in India in
terms of child malnutrition. While India has 38.7 per cent and 29.4 per
cent of children suffer from stunted growth and underweight. Nearly
42.4 per cent and 32.7 percent of children from schedule caste (SC)
suffer from stunted and underweight, respectively. The percentage of
stunted and underweight children from SC groups is more than the
national level. The level of nutrition among children improves with the
social status.
Almost 38.9 per cent and 29.6 per cent of Children from Other
Backward Classes (OBCs) suffer from growth retardation (Stunted)
and low body weight (underweight) respectively. The percentage
of wasted children among the social groups is high Schedule Tribe
(18.7), the percentage of wasted children reduce with the social status.
Schedule caste and Other Backward Class have only 15.5 percent and
14.8 percent of wasted children. Government has to implement some
more effective programmes mainly focusing on the socially backward
group of the country to reduce the extent of malnutrition.
Nutrition and health care both are very crucial in the early stages
of life. Nutrition acts both as an essential element on the one hand and
increased the rate of child survival on the other hand. Healthcare is
also very necessary for the growth and development of children. Lack
of adequate nutrition increased the risk of mortality.
Child mortality is very sensitive indicator for the socio-economic
development of the country. Infant Mortality Rate (IMR) and Under-5
Mortality Rate (U5MR) are the most important component of child
mortality. Infant Mortality Rate is the probability of dying of child
within the first year of his life per thousand live births while U5MR is
an indicator of the risk of death of child within the first five years of life.
U5MR is also a global indicator of health and used to assess the impact
of various interventions at improving the child health and survival.
Volume 3 • Issue 1 • 10000138
Citation: Usmani G, Ahmad N (2017) Health Status of Children in India. 3: 138. doi:10.4172/2471-9870.10000138

Page 3 of 7

States Stunted Severely Stunted Wasted Severely Wasted Underweight Severely Underweight
AP 35.4 12.0 19.0 6.0 22.3 4.7
ASM 40.6 21.0 9.7 2.7 22.2 7.0
BR 49.4 26.1 13.1 3.9 37.1 14.7
GUJ 41.6 18.3 18.7 6.7 33.6 10.1
HAR 36.5 19.3 8.8 2.7 22.7 7.5
Kar 34.2 15.1 17.0 6.3 28.9 9.8
KER 19.4 8.0 15.5 5.4 18.5 5.7
MP 41.5 18.5 17.5 5.4 36.1 12.0
MAH 35.4 10.0 18.6 6.3 25.2 5.7
ORS 38.2 15.5 18.3 4.9 34.4 11.0
PUJ 30.5 13.1 8.7 3.2 16.0 4.3
RAJ 36.4 17.3 14.1 2.9 31.5 11.2
TN 23.3 9.3 19.0 6.3 23.3 6.1
UP 50.4 28.4 10.0 2.9 34.3 12.9
WB 34.7 12.8 15.3 3.9 30.0 8.9
INDIA 38.7 17.3 15.1 4.6 29.4 9.4
Table 1: Extent of malnutrition among children, age 0-59 months in major states (in percentage).

Malnutrition NFHS-2 NFHS-3 RSoC 2013-14 % Change*-** % Change *-***

Stunted 51 45 38.7 -0.12 -0.24
Wasted 20 23 15.1 0.15 -0.25
Underweight 43 40 29.4 -0.070 -0.32
*- NFHS-2; **-NFHS-3; ***- RSoC 2013-2014 [1,3,4]

Table 2: Percentage change in nutritional status of children in India.

  SC ST OBC INDIA
Stunted 42.4 42.3 38.9 38.7
Severely Stunted 19.3 19.5 17.8 17.3
Wasted 15.5 18.7 14.8 15.1
Severely Wasted 4.9 5.3 4.4 4.6
Underweight 32.7 36.7 29.6 29.4
Severely Underweight 10.8 13 9.3 9.4
Source: Rapid survey on children, 2013-2014 [1]

Table 3: Nutritional status of children by social category (percentage).

Infant Mortality Rate (IMR)

90
Infants are the most sensitive and vulnerable section of the 80 80 79
population. Infants show a higher rate of mortality among all other 74 74 74 72
70 71 72 70
indicators of child survival. Neo-natal Mortality (NNM) and post-natal 68 66
63
Mortality (PNM) are the components of IMR. NNM and PNM have 60 60 58 58
57 55
a lower rate because most of these deaths often biological in nature 53
50 50
47
especially. All these constituents of IMR are expressed at per 1000 live 44 42
40 40
births. Infant mortality is defines as the number of deaths in the first
30
year of child’s life per thousand live births in the given year. Though at 1990 1995 2000 2005 2010 2015
the all India level IMR has declined continuously since after the reform,
Source: Sample registration system, office of the registrar general of India, 1991-
yet it was as high as 40 per thousand live birth in 2013 [6]. 2013 [6]

Figure 2 show the trends in infant mortality rate since 1990 in
India. From 80 in 1991 IMR has come down 66 in 2001. It was recorded
at 58 in 2005 from 66 in 2001. It was seen that the number of infant
deaths declined almost at a constant rate but after the launch of NRHM
(2005) the percentage growth of declining infant mortality is somewhat
constant but more than before the introduction of NRHM. From 80
per 1000 live births in 1990 IMR has reduced to 40 per thousand live
births in 2013 (SRS).
Table 4 presented the infant mortality rate in India and her major
states. The rate of reduction in infant mortality rate calculated by the
compound annual growth rate (CAGR) is -0.03 percent at the national
Figure 2: Infant mortality rate in India, 1990-2013.
level. Among the states, India is experiencing a big diversity in the rate
of infant mortality. The states like Madhya Pradesh (54) and Assam
(54) have the highest number of infant deaths in the country. The states
of Uttar Pradesh (50), Rajasthan (47), Bihar (42), Haryana (41) Andhra
Pradesh (39), have IMR above the national average (40) per thousand
live births in 2013. Kerala (12) has the least number of IMR followed by
Tamil Nadu (21) in 2013 (SRS).
The highest compound annual rate of decline in IMR is found in
the states of Tamil Nadu. From 76 per 1000 live births in 1987 it comes

J Perioper Crit Intensive Care Nurs

ISSN: 2471-9870 JPCIC, an open access journal Volume 3 • Issue 1 • 10000138
Citation: Usmani G, Ahmad N (2017) Health Status of Children in India. 3: 138. doi:10.4172/2471-9870.10000138

Page 4 of 7

down to 21 per thousand live births in 2013 and shows a CAGR of improvements in the infant’s survival rate in 2005-2012. The rate of
-0.05 percent, followed by the states of Maharashtra and Gujarat both fall in infant’s deaths calculated by compound annual growth rate is
have a CAGR of -0.04 percent, respectively. The lowest reduction is higher in urban areas (-0.044%) comparatively to rural areas (-0.040%).
found in the states of Assam. In 1987 Assam has 102 IMR; it falls to 54 As the world development report 2004 finding presented that if the
per thousand live births in 2013. Assam has -0.02 percent compound health services, delivered well, will improve health outcomes for even
annual growth rate (CAGR) which is lowest among all the major states the poorest groups. In 2012, rural IMR was 46 percent per thousand
in the study. It is well known fact that mother’s education, higher birth live births against the 28 percent urban IMR. The causal factor of this
interval, higher maternal age at birth, ante-natal care, breast feeding gap is that the urban women have better education facilities, healthcare
and access to proper medical care play a vital role in determining the facilities, easily accessible healthcare centres, etc.
child survival rate especially infants [7]. Infant mortality by residence shows that rural infants are less cared
Table 5 presents a picture of disparity in infant’s deaths at rural- for than their urban counterpart. This is an effective cause of higher
urban level. There is a gap of 18 points at all India level. Though it infant mortality rate in rural areas of the country. India experiences
has improved between 2005 and 2012 by 6 points, but still the gap is a huge difference in rural-urban rates of Infant deaths. In rural areas
very large. In 2005 rural areas IMR was recorded at 64 per thousand where healthcare services are rarely available and if, available they are
live births while in urban areas it was only 40 percent per thousand not sufficient to catering such a big population. Infant mortality rates
live births. It shows a gap of 24 points in 2005. Moreover this gap are quite high in rural areas as comparatively to urban areas of the
is very large at state level. In some states there have been significant country.
In rural areas of the Indian major states IMR ranges from 13 to
States 1987 1991 2001 2011 2012 2013 CAGR % 58 percent and 9 to 39 percent in urban areas. Figures show that there
AP 79 73 66 46 43 39 -1.975 is a gap of almost 50 percent among rural and urban areas. Among
ASM 102 81 74 58 55 54 -1.972 the better performing states in terms of rural IMR Kerala leads and is
BR 101 69 62 48 44 42 -1.980 much ahead of the rest states. Kerala has IMR of 13 per 1000 live births
GUJ 97 69 60 44 41 36 -1.983 in rural areas and 9 percent per thousand live births in urban areas.
HAR 87 68 66 48 44 41 -1.977 Other states of Tamil Nadu (24), Maharashtra (30) and Punjab (30)
KAR 75 77 58 38 35 31 -1.980 also performed better in rural areas.
KER 28 16 11 13 12 12 -1.979
MP 120 117 86 62 59 54 -1.978 Neonatal Mortality Rate
MAH 66 60 45 28 25 24 -1.983
Almost 0.76 million new-borns die every year in India, the highest
ORS 126 124 91 61 57 51 -1.981
among all the countries in the world. Neo-natal mortality (NNM) is the
PUJ 62 53 52 34 30 26 -1.980
deaths of a new-born before completing 29 days of his life. At the all
RAJ 102 79 80 55 52 47 -1.977
India level the NNM is 29. The NNM of the country falls from 51 per
TN 76 57 49 24 22 21 -1.988
1000 live births in 1991 to 29 per thousand live births in 2012. The rate
UP 127 97 83 61 57 50 -1.982
of decline has been slow, as compared to IMR and U5MR. The major
WB 71 71 51 31 32 31 -1.979
causes of neonatal mortality are preterm birth complication, infection
INDIA 95 80 66 47 44 40 -1.980
during birthing. About 2/3 of infant deaths and half of under-5 deaths
Source: Sample registration system, office of the registrar general of India, CAGR
are during the neonatal period of the new-born.
is taken from Annexure 1 [6]

Table 4: Infant mortality rate in India since 1987 to 2013. Neonatal mortality rate has declined over the years. Figure 3
presented the NNM has declined from 51 in 1991 per 1000 live births
Rural urban to 29 per thousand live births in 2012. Over the period from 1991-2012
States CAGR % CAGR %
2005 2012 2005 2012 neonatal mortality has reduced by 0.57 percent [8].
Andhra Pradesh 63 46 -1.83 39 30 -1.81
Same is in the case of rural and urban areas but data available
Assam 71 58 -1.78 39 33 -1.77
from the government sources indicate that the rate of reduction is
Bihar 62 44 -1.84 47 34 -1.83
Gujarat 63 45 -1.84 37 24 -1.86
higher in rural areas comparatively to urban areas (Table 5). Rural
Haryana 64 46 -1.83 45 33 -1.83
areas accounted for 0.60 percent reduction in NNM while urban areas
Karnataka 54 36 -1.85 39 25 -1.86
account only 0.50 percent in 1991-2012. The rural NNM falls from 55
Kerala 15 13 -1.75 12 9 -1.82
per thousand in 1991 to 33 per 1000 live births in 2012, likewise urban
Madhya Pradesh 80 60 -1.82 54 37 -1.85
NNM has fallen only to 16 percent per thousand live births in 2012
Maharashtra 41 30 -1.83 27 17 -1.87
from 32 percent per 1000 live births in 1990’s. The Average Annual
Orissa 78 55 -1.84 55 39 -1.84
Growth Rate (AAGR) of reduction of NNM was only modest at around
Punjab 49 30 -1.87 37 24 -1.86 -1.961 percent in the period from 1991-2012. The rate of reduction in
Rajasthan 75 54 -1.83 43 31 -1.83 neonatal mortality is somewhat less than that of infant mortality during
Tamil Nadu 39 24 -1.87 34 18 -1.90 the same period (-1.989 percent annual reduction) (Table 6).
Uttar Pradesh 77 56 -1.83 54 39 -1.83 Figure 4 shows that the neonatal mortality is not uniform in the
West Bengal 40 33 -1.78 31 26 -1.77 states as well. The states of Kerala (7) and Tamil Nadu (15) have lowest
INDIA 64 46 -1.83 40 28 -1.84 NNM across the country; Odisha (39), Uttar Pradesh (37) and Madhya
Source: Sample registration system, govt. of India, CAGR taken from Annexure Pradesh (39) have very NNM. There is a big diversity in the northern
2 [6] and southern states in terms of NNM. The southern states perform well
Table 5: Infant mortality rate by residence in India and major states. in reducing neonatal mortality rate as compared to northern states.

J Perioper Crit Intensive Care Nurs

ISSN: 2471-9870 JPCIC, an open access journal Volume 3 • Issue 1 • 10000138
Citation: Usmani G, Ahmad N (2017) Health Status of Children in India. 3: 138. doi:10.4172/2471-9870.10000138

Page 5 of 7

years of his/her life. Child mortality rate is calculated at per thousand

60 child population per year. Most of the child deaths were reported in the
55 55 54
51 50 52 52 52 50 51
states namely Madhya Pradesh, Uttar Pradesh, Assam, Rajasthan and
50 49 49 49
45
47 48 48 47 46
45 45 44 44 44 Bihar. These states are also marked by some of the highest poor people
40 40 40 41 41 41 41 40 39
38
and illiterate people in India. Child mortality is an important indicative
37 37 37 37 36
35 35 34 36 34 of the country’s general medical and public health condition and hence
32 33 33 33 33
30 31
29 28 29
25
28
26 27
28 27
25 24
the country’s level of socio-economic development. Additionally, the
24 23 23
20
22 22 21 21
19 robustness of a public health system has been highlighted as a necessary
17 16
15 component to achieve the Millennium Development Goals (MDG)
10
[9]. Socio-economic condition, health and literacy level of mother are
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Total Rural Urban
some of the important factors of child mortality rate. Diaherea and
malnutrition are the main causes of deaths in this group. Most of these
Source: SRS statistical report 2012, Government of India [6]
deaths could be preventable by effective and low cost interventions.
Figure 3: Neo-natal mortality rate in India 1991-2012. Table 7 shows the glaring disparity in child mortality in India and her
major states. Child mortality rate comes down to 11.5 percent in 2012
from 16.6 percent in 1991. This reduction of CMR is also observed in
Year Total Rural Urban
almost all states. The highest CMR is observed in the states of Madhya
1991 51 55 32
Pradesh (17.8) followed by Uttar Pradesh (16.8) and Assam (16.5). The
1995 48 52 29
states of Orissa (14.7), Rajasthan (14.3) and Bihar (11.5) have above
2000 44 49 27
than national average child mortality rate (11.5 percent). The states of
2005 37 41 23
2010 33 36 19
Kerala with 2.5 percent child mortality rate is the best performing states
2011 31 34 17
in the country, followed by the states of Tamil Nadu (4.9), Maharashtra
2012 29 33 16
(5.2), Punjab (7.4), West Bengal (7.6) and Karnataka (8.0) [10].
% Change 0.57 0.60 0.50 The figures of CMR presented in Table 7 reflect the inadequacy as
AAGR % -1.961 -1.957 -1.968 well as disparity in the healthcare sector of the country and her states
Source: SRS statistical report, 2012, govt. of India, % change and AAGR taken respectively. Table 7 depicts a picture of huge difference between the
from Annexure 3 [6] northern and southern states in terms of CMR. Generally, the southern
Table 6: NNM in India 1990-2012. states do better and have very low percentage of child mortality as
comparatively to northern states of the country. The ranks of high
developed states (Kerala, Tamil Nadu, Andhra Pradesh, Karnataka) in
terms of child mortality rate are higher than the less developed states
INDIA, 29
AP, 27 (Madhya Pradesh, Uttar Pradesh, Rajasthan, Assam, Orissa).
WB , 22 ASM, 29
Figure 6 presented the rural-urban gap in child mortality in India
UP, 37 and her major states. The picture of CMR is gloomier in rural areas than
BR, 28 urban areas. The rural-urban gap is almost double and in some states
TN, 15 it is more than double. This is because of the inter-regional diversity
GUJ, 28 in major states. Rural healthcare infrastructure is not adequate and
historically neglected. Rural healthcare infrastructure and facilities are
RAJ, 35
HAR, 28 less efficient compared to that in urban areas. The highest rural/urban
gap is observed only in the states of Madhya Pradesh with 19.5 percent
PUJ, 17 KAR, 23 CMR per 1000 children (0-4 years) in rural areas and 10 percent per
ORS, 39 MP, 39
1000 children (0-4 Years) in urban areas. The lowest rural/ urban gap in
CMR was achieved by Kerala (2.6/1.9 percent) followed by Tamil Nadu
MAH, 18 KER, 7 (5.5/4.1 percent). Even after government has been taken various steps
to reduce the child mortality rate, the situation is not improved even in
Source: Sample registration system, statistical report, 2012 [6] the best performing states. Gujarat is relatively a more developed state
Figure 4: Share of neonatal mortality by major states. but has very high Rural/urban gap in child mortality rate (12.9/7.1)

Neonatal mortality is the most sensitive among the child mortality

indicators. The neonatal deaths contribute a larger portion in infant Rest 44%
Under-5
deaths

mortality and under-five mortality of the country. To achieve our NNM 56%
targeted goals of reducing IMR and U5MR we have to ensure a
Rest 31%
substantial reduction in neonatal mortality. India accounts 29 percent
Deaths
Infant

NNM per thousand live births in 2012, almost 70 percent of infant die NNM 69%
in their neonatal period (Figure 5) and more than half of under-five 0% 10% 20% 30% 40% 50% 60% 70% 80%
mortality in the country fall in the neonatal period (Figure 5).
Source: SRS, statistical report, 2012 [6]
Child Mortality Rate (CMR) Figure 5: Neonatal deaths as a percentage of infant deaths and of under-5
deaths.
Child mortality is defined as the death of child before completing 4

J Perioper Crit Intensive Care Nurs

ISSN: 2471-9870 JPCIC, an open access journal Volume 3 • Issue 1 • 10000138
Citation: Usmani G, Ahmad N (2017) Health Status of Children in India. 3: 138. doi:10.4172/2471-9870.10000138

Page 6 of 7

close to that of Uttar Pradesh (17.6/12.7), Assam (17.6/7.5), Rajasthan
(15.6/8.8), Bihar (11.8/7.9), respectively. This means that provision of
healthcare is more important than economic advancement as in the
case of the states of Kerala a moderately advanced state, has very low
rate of child deaths as compared to Maharashtra, Gujarat and Haryana.
Table 8 presents the component of child mortality. India accounts
more than a quarter of global Neo-Natal Mortality. Two-thirds of
infant deaths and almost half of under-5 deaths are during the neonatal
period of life. The IMR has reduced over the years but reduction
is at a much slower rate as compared to the U5MR. The percentage
of reduction of IMR in the period from NFHS-1 to NFHS-2 is -0.14
percent and from NFHS-1 to SRS-12 is -0.47 percent. The highest
percentage of reduction is seen in the U5MR, between NFHS-1 to SRS-
12 the percentage reduction of U5MR is -0.52 percent. Over the same
period of time Neo-Natal Mortality reduced to -0.41 from NFHS-1 to
SRS-12.
Figure 7 presents the under-5 mortality rate by residence from 2009
to 2013. According to the SRS 2012, U5MR in India stood at 52 in 2012
compared to the 74 in NFHS-3. In 2009 the number of U5MR for rural
areas was 71 while it is 41 for urban areas. The rural-urban gap seems to
be constant over the period of time from 2009 to 2013. Rural areas have
nearly double burden of U5MR since after the Independence. Figure
shows the data from 2009 to 2013, in 2009 the number of U5MR in
rural and urban areas is 71 and 41 respectively. The numbers reduce to
61 for rural areas and 35 for urban areas in 2011. Again the rural-urban
gap is almost constant. In 2013, U5MR for rural (55) and for urban
(29) the gap percentage of reduction between rural and urban is almost
same over the entire period of time. We can say that rural areas need
more attention by policy makers to intervene efficiently in the child
health status.
Table 9 presents the Millennium Development Goals for 2015 and
child mortality rates (IMR, U5MR). India is unlikely lag behind in
achieving the MDG goals-4 for 2015 to reduce the under-5 mortality
rate by two third. In 1990 the number of U5MR was 109 per 1000 live
births the number declined to 49 in 2012 just close to the target of 42.
IMR is 80 per 1000 live births in 1990 which decline to 42 in 2013.
Country is lag behind in achieving the target of 28 IMR by 2015 (MDG-
4) [11,12].

States 1991 2001 2006 2007 2008 2009 2010 2011 2012
AP 21.3 16.0 15.2 14.6 13.2 11.6 10.4 9.7 8.8
ASM 32.4 23.6 19.7 18.2 20.4 19.0 17.9 17 16.5
BR 22.8 19.4 18.5 18.9 16.3 14.7 13.4 12.4 11.5
GUJ 23.3 18.5 16.2 15.1 13.7 13.7 12.9 12.1 10.9
HAR 23.0 19.2 16.2 15.2 14.5 13.3 12.5 11.3 10.7
KAR 23.6 16.2 12.5 12.1 12.3 11.0 10.3 8.6 8.0
KER 4.3 2.6 3.2 2.8 2.4 2.6 2.9 2.6 2.5
MP 44.5 28.1 24.3 23.5 22.6 21.4 20.0 18.8 17.8
MAH 16.3 10.3 8.8 8.4 7.9 6.8 6.4 5.1 5.2
ORS 39.0 24.4 22.0 20.0 19.5 18.4 17.1 15.8 14.7
PUJ 17.0 14.1 11.0 11.1 10.2 9.5 8.7 7.4 7.4
RAJ 30.9 24.3 22.4 19.5 18.8 17.2 16.2 15 14.3
TN 16.1 11.8 9.2 8.4 7.3 6.7 5.8 5.0 4.9
UP 35.6 26.8 23.9 22.3 21.6 20.1 19.6 17.9 16.8
WB 20.6 13.3 9.7 9.2 8.5 7.9 7.4 7.8 7.6
INDIA 16.6 19.3 17 16 15.2 14.1 13.3 12.2 11.5
Source: Compendium of India’s fertility and mortality indicators 1971-2007, RGI and health and family welfare statistics in India 2013 [10]

Table 7: Child mortality rate in India since 1991 to 2012.

Rural Urban
25
19.5
20 17.6 17.6
15.5 15.6
15 11.8 12.9 11.6 12.7 12.8
10 8.9 10
10 7.5 7.9 7.1 8.4 6.4 8.2 8.3 8.8 8.2
6 5.9 7
5.7 5.5 5.4
4.1 4.1
5 2.6
1.9
0
KER

WB
ORS

INDIA
ASM

RAJ
MP

MAH
AP

PUJ
BR

HAR

KAR

UP
GUJ

TN

Source: Health and family welfare statistics in India 2013 [10]

Figure 6: Child mortality rate by residence in India, 2012.

J Perioper Crit Intensive Care Nurs

ISSN: 2471-9870 JPCIC, an open access journal Volume 3 • Issue 1 • 10000138
Citation: Usmani G, Ahmad N (2017) Health Status of Children in India. 3: 138. doi:10.4172/2471-9870.10000138

Page 7 of 7

% Change between NFHS-1 % Change between NFHS-3 % Change between NFHS-1

NFHS-1 NFHS-2 NFHS-3 SRS-12
and 2 and SRS-12 and SRS-12
IMR 79 68 57 42 -0.14 -0.26 -0.47
U5MR 109 95 74 52 -0.13 -0.30 -0.52
NMR 49 43 39 29 -0.12 -0.26 -0.41
Source: NFHS and sample registration system, statistical report 2012 [6]

Table 8: Child mortality indicators in India.

80
R
70 71 U
66
60 61
58
55
50

40 41
38
35
32
30 29
20
2009 2010 2011 2012 2013
Source: Sample registration system, office of registrar general of India [6]

Figure 7: Under-five mortality by residence in India.

1990 levels Goal for 2015 Current levels

U5MR 109 42 49
IMR 80 28 42
Source: NFHS-1; SRS 1990, 2012, 2013 [5,6]

Table 9: Millennium development goals of child mortality and current levels.

Conclusion
It is proved from the above discussion that the child health status
of India is very poor and there are wide inter-state disparities in the
country. Though child health shows improvement over the years but
still India is far behind in terms of child health standard because of
the increasing population of the country. Child health status is in very
pity condition and overall health status of the country is not improving
without the improvement in the health condition of children.
References
1. Rapid Survey on Children (2013-2014) Ministry of women and child
development. Government of India.
7. Government of India (2006) Bulletin on rural health statistics in India. Ministry
of health and family welfare, New Delhi.
8. Government of India (2012) Universal health coverage report, New Delhi.
9. Farahani M, Subramanian SV (2009) The effect of changes in health sector
resources on infant mortality in the short-run and the long-run: A longitudinal
econometric analysis. Soc Sci Med 68: 1918–1925.
10. District level household survey reports (I, II, III) (2013) Ministry of health and
family welfare, New Delhi.
11. National Sample Survey Organization reports. Ministry of statistics and
programme implementation, Government of India: New Delhi.
12. Pradhan M, Sahn DE, Younger SD (2003) Decomposing world health inequality.
J Health Econ 22: 271-293.

2. WHO (2014) World health statistics. Global health observatory data.

3. National Family Health Survey-2 (1998-1999) International institute for

population sciences, India.

4. National Family Health Survey-3 (2005-2006) International institute for

population sciences, India.

5. National Family Health Survey (1992-1993) International institute for population

sciences, India.

6. Sample registration system bulletin (2013) Office of registrar general of India, 48: 2.

J Perioper Crit Intensive Care Nurs

ISSN: 2471-9870 JPCIC, an open access journal Volume 3 • Issue 1 • 10000138